Declaration of potential conflict of interest of authors/collaborators of 7th Brazilian Guideline of Arterial Hypertension If the last three years the author/developer of the Guidelines:
| Names Membersof the Policy | Participated in clinical studies and / or experimental trials supported by pharmaceutical or equipment related to the guideline in question | Has spoken at events or activities sponsored by industry related to the guideline in question | It was (is) advisory board member or director of a pharmaceutical or equipment | Committees participated in completion of research sponsored by industry | Personal or institutional aid received from industry | Produced scientific papers in journals sponsored by industry | It shares theindustry |
|---|---|---|---|---|---|---|---|
| Alexandre Alessi | No | No | No | No | No | No | No |
| Ana Cristina Simões e Silva | No | No | No | No | No | No | No |
| Andrea Araujo Brandão | Novartis | Biolab, Daiichi Sankyo, Novartis, Servier | No | No | Biolab, Daiichi Sankyo, Novartis, Servier | Biolab, Novartis, Servier, SEM | No |
| Angela Maria Geraldo Pierin | No | No | No | No | No | No | No |
| Antonio Carlos Cordeiro Júnior | No | No | No | No | No | No | No |
| Armando da Rocha Nogueira | No | No | No | No | No | No | No |
| Audes Diógenes Feitosa | No | No | No | No | No | No | No |
| Carlos Alberto Machado | No | No | No | No | No | No | No |
| Carlos Eduardo Poli de Figueiredo | No | No | No | No | No | No | No |
| Celso Amodeo | Servier | No | Biolab | Servier | Ache, Servier, Merck Serona, AstraZeneca, Biolab | Novartis | No |
| Cibele Isaac Saad Rodrigues | No | No | No | No | No | No | No |
| Cláudia Lúcia de Moraes Forjaz | No | No | No | No | No | No | No |
| Fernando Antonio Almeida | No | No | No | No | No | No | No |
| Frida Liane Plavnik | No | No | No | No | No | No | No |
| Paulo César Veiga Jardim | No | Biolab - Servier - Novartis - Aché | No | No | Servier, Ministério da Ciência, CNPq | No | No |
| Deborah Malta | No | No | No | No | No | No | No |
| Décio Mion Júnior | No | No | No | No | No | No | No |
| Dilma do Socorro Moraes de Souza | No | No | No | No | No | No | No |
| Eduardo Barbosa Coelho | No | No | No | No | No | No | No |
| Eduardo Costa Duarte Barbosa | Novartis, Servier, MSD, Takeda, Amgen, AstraZeneca, Pfizer | No | No | No | Servier, Biolab | No | No |
| Elizabeth Muxfeldt | No | No | No | No | No | No | No |
| Emilton Lima Júnior | No | Biolab | No | No | No | No | No |
| Fernanda Consolim Colombo | Ache,Novartis | Daiichi Sankyo,Servier,Merck,Boehringer, Novartis | No | No | No | Libbs,Merck | No |
| Fernando Nobre | No | Novartis Biociências,Merck Soreno,SEM,Sanofi-Aventi,Libbs Farmacêutica | No | Novartis Biociências,Libbs Farmacêutica | Sanofi-Aventis,Libbs Farmacêutica | SEM,Novartis Biociências,Biolab,Torrent,Bayer,Libbs Farmacêutica | No |
| Flávio Antonio de Oliveira Borelli | No | Servier | No | No | No | No | No |
| Gil Fernando Salles | No | No | No | No | No | No | No |
| Gilson Soares Feitosa | No | No | No | No | No | No | No |
| Giovanio Vieira da Silva | No | No | No | No | No | No | No |
| Guido Bernardo Aranha Rosito | No | No | No | No | No | No | No |
| Heitor Moreno Júnior | No | No | No | No | No | No | No |
| Heno Ferreira Lopes | No | No | No | No | No | No | No |
| Isabel Cristina Britto Guimarães | No | No | No | No | No | No | No |
| Ivan Carlos Antonello | No | No | No | No | No | No | No |
| José Fernando Vilela Martim | No | No | No | No | No | No | No |
| José Marcio Ribeiro | No | Biolab,B Ingelheim,Pfizer | No | No | Servier | No | No |
| Juan Yugar Toledo | No | No | No | No | No | No | No |
| Leda Aparecida Daud Lotaif | No | No | No | No | No | No | No |
| Lilian Soares da Costa | No | No | No | No | No | No | No |
| Lucélia Batista Neves Cunha Magalhaes | No | No | No | No | No | No | No |
| Luciano Ferreira Drager | No | No | No | No | No | No | No |
| Luis Cuadrado Martins | No | No | No | No | No | No | No |
| Luiz Aparecido Bortolotto | Novartis | Servier, Biolab, Novartis | No | No | No | Biolab, Novartis, Servier, Baldacci | No |
| Luiz Carlos Bodanese | Sanofi, GSK, Roche | Sanofi, Novartis, Boehringer | No | Servier, Sanofi, ANGEM | Safoni, ANGEM, GSK | Pfizer | No |
| Luiz Cesar Nazario Scala | No | No | No | No | No | No | No |
| Marcia Maria Godoy Gowdak | No | No | No | No | No | No | No |
| Marcia Regina Simas Torres Klein | No | No | No | No | No | No | No |
| Marco Antonio Mota Gomes | Novartis, AstraZeneca, Biolab, Daiichi Sankyo,Takeda, Torrent, Libbs, Pfizer, Janssen, Cardios, Omron | No | No | No | No | No | No |
| Marcus Vinícius Bolívar Malachias | No | Biolab, Chiesi, Medley-Sanofi, Novartis, Pfizer | No | No | No | Biolab, Boehringer-Ingelheim, Novartis | No |
| Maria Eliane Magalhães | AstraZeneca, Novartis, Sanofi-Aventis, Daiichi Sankyo | AstraZeneca, Pfizer, Sanofi-Aventis, MSD, Chiesi | No | No | AstraZeneca, Pfizer, MSD, Novartis | No | No |
| Maria Regina Torloni | No | No | No | No | No | No | No |
| Maria Rita de Figueiredo Lemos Bortolotto | No | No | No | No | No | No | No |
| Mário Fritsch Toros Neves | Novartis, Servier, AstraZeneca, Pfizer, Sanofi, Libbs | No | Novartis, Servier | No | No | No | No |
| Miguel Gus | No | No | No | No | No | No | No |
| Nelson Sass | No | No | No | No | No | No | No |
| Osni Moreira Filho | No | No | No | No | Biolab, Pfizer, Novartis | EMS | No |
| Oswaldo Passarelli Júnior | Biolab, Novartis, Daiichi Sankyo | ||||||
| Paulo Koch Nogueira | No | No | No | No | No | No | No |
| Roberto Dischinger Miranda | Aché, Astra Zeneca, Bayer, Biolab, Boeringher Ingelheim, MSD, Novartis, Pfizer | No | Bayer, Novartis, Pfizer | No | No | No | No |
| Roberto Jorge da Silva Franco | No | No | No | No | No | No | No |
| Rogério Baumgratz de Paula | No | No | No | No | No | No | No |
| Rui Manuel dos Santos Póvoa | No | No | No | No | No | No | No |
| Sandra Fuchs | No | No | No | No | No | No | No |
| Sebastião Ferreira Filho | No | No | No | No | No | No | No |
| Sergio Kaiser | Bristol-Myers-Squibb, Novaquimica, Abbott | No | No | No | No | No | No |
| Thiago de Souza Veiga Jardim | Novartis, Astra Zeneca | Biolab, Daiichi Sankyo, Novartis, Astra Zeneca, Servier | Daiichi Sankyo, Servier | Daiichi Sankyo | |||
| Vera Koch | No | No | No | No | No | No | No |
| Victor Matsudo | No | No | No | Instituto Actigraph | No | No | No |
| Weimar Kunz Sebba Barroso de Souza | Amgen, AstraZeneca, Bayer, Boehringer, Jonhson & Johnson, Libbs, Lilly, Merck Sharp Dhome, Novartis, Pfizer, Roche, Sanofi Aventis, Daiichi Sankyo, Torrent | AstraZeneca, Biolab, Boehringer, Lilly, Servier, Torrent | No | No | No | No | No |
| Wille Oigman Cobrei | Libbs | No | No | No | No | No | No |
Introduction
On behalf of the Brazilian Society of Cardiology, Brazilian Society of Hypertension and Brazilian Society of Nephrology, I present to you the 7th Brazilian Guideline of Arterial Hypertension, result of the joint work of an expert team of renowned professionals appointed by their respective medical societies.
The production of this new guideline was necessary to update the knowledge accumulated over the past years, considering the Brazilian reality and clinical practice. The guidance and recommendations contained in this document reflect the evidence of the effectiveness of the interventions. The present text does not deal specifically with cost-effectiveness analyses. The major objective of the medical societies and authors is to guide health professionals on the preventive measures and care for individuals with arterial hypertension, aiming at reducing the complications of arterial hypertension, considered the major risk factor for cardiovascular disease.
The following table was used as reference for the grades of recommendation and levels of evidence.
| Grades of recommendation: |
| Class I: Conditions to which there is conclusive evidence or at least general consensus concerning the safety and usefulness/efficacy of the intervention; |
| Class II: Conditions to which there is conflicting evidence and/or disagreement of opinion concerning the safety and usefulness/efficacy of the intervention; |
| Class IIa: Evidence/opinion in favor of the intervention. Most experts agree; |
| Class IIb: Less well-established safety and usefulness/efficacy, without predominance of favorable opinions on the intervention; |
| Class III: Conditions to which there is evidence and/or consensus that the intervention is not useful/effective, and, in some cases, even harmful. |
| Levels of evidence: |
| Level A: Data derived from multiple consistent randomized controlled clinical trials, and/or a robust meta-analysis of randomized clinical trials; |
| Level B: Data derived from a less robust meta-analysis, one single randomized trial or non- randomized trials (observational); |
| Level C: Data derived from consensual expert opinion. |
| We hope the concepts expressed in this guideline can be widely spread to a better and more comprehensive care of individuals with arterial hypertension. |
Marcus Vinícius Bolívar Malachias
Abbreviations of the Brazilian Guideline of AH
| ABI | Ankle-brachial index | ||
| ABPM | Ambulatory blood pressure monitoring | IDF | International Diabetes Federation |
| AC | Abdominal circumference | IGF-1 | Insulin-like growth factor 1 |
| ACC | American College of Cardiology | IHD | Ischemic heart diseases |
| ACEI | Angiotensin-converting-enzyme inhibitor | IMT | Intima-media thickness |
| ACTH | Adrenocorticotropin | IPEMs | State Departments of Weights and Measures |
| AH | Arterial hypertension | ISH | Isolated systolic hypertension |
| AHA | American Heart Association | IV | Intravenous |
| AHI | Apnea-hypopnea index | LVH | Left ventricular hypertrophy |
| AKI | Acute kidney injury | LVMI | Left ventricular mass index |
| Aldo | Aldosterone | MH | Masked hypertension |
| AMI | Acute myocardial infarction | MI | Myocardial infarction |
| APA | Aldosterone-producing adenoma | MIBG | Metaiodobenzylguanidine |
| APE | Acute pulmonary edema | MRI | Magnetic resonance imaging |
| ARB | Angiotensin II receptor blocker | MS | Metabolic syndrome |
| BB | Beta-blocker | NKF | National Kidney Foundation |
| BMI | Body mass index | NPT | Non-pharmacological treatment |
| BP | Blood pressure | OSAHS | Obstructive sleep apnea-hypopnea syndrome |
| CAD | Coronary artery disease | PAD | Peripheral arterial disease |
| CAH | Chronic arterial hypertension | PE | Preeclampsia |
| CbVD | Cerebrovascular diseases | PH | Prehypertension |
| CCB | Calcium-channel blocker | PHA | Primary hyperaldosteronism |
| CDC | Centers for Disease Control and Prevention | PHEO | Pheochromocytoma |
| CHF | Congestive heart failure | PNS | Brazilian National Health Survey |
| CKD | Chronic kidney disease | POF | Survey on Family Income |
| COPD | Chronic obstructive pulmonary disease | PP | Pulse pressure |
| CPAP | Continuous positive airway pressure | PRA | Plasma renin activity |
| CrCl | Creatinine clearance | PSNS | Parasympathetic nervous system |
| CS | Cushing’s syndrome | PTH | Parathormone |
| CT | Computed tomography | PVR | Peripheral vascular resistance |
| CV | Cardiovascular | PWV | Pulse wave velocity |
| CVD | Cardiovascular disease | RAAS | Renin-angiotensin-aldosterone system |
| CVRF | Cardiovascular risk factor | RAH | Resistant arterial hypertension |
| DAH | Diastolic arterial hypertension | RBMLQ | Brazilian Legal Metrology and Quality Network |
| DBP | Diastolic blood pressure | RF | Risk factor |
| DHA | Docosahexaenoic acid | RVAH | Renovascular arterial hypertension |
| DIU | Diuretic | SAH | Systemic arterial hypertension |
| DM | Diabetes mellitus | SBP | Systolic blood pressure |
| EPA | Eicosapentaenoic acid | SNP | Sodium nitroprusside |
| GFR | Glomerular filtration rate | SNS | Sympathetic nervous system |
| GH | Growth hormone | SUS | Brazilian Unified Health Care System |
| GRS | Global Risk Score | TC | Total cholesterol |
| HbA1c | Glycated hemoglobin | TIA | Transient ischemic attack |
| HBPM | Home blood pressure monitoring | TOD | Target-organ damage |
| HC | Hypertensive crisis | TSH | Thyroid stimulating hormone |
| HD | Hypertensive diseases | UACR | Urine albumin/creatinine ratio |
| HDL-C | High-density lipoprotein cholesterol | US | Ultrasonography |
| HE | Hypertensive emergency | VIGITEL | Surveillance for Risk Factors and Protection Against Chronic Diseases via Telephone Inquiry |
| HF | Heart failure | WCE | White-coat effect |
| HR | Heart rate | WCH | White-coat hypertension |
Marcus Vinícius Bolívar Malachias